In a previous study [3], we carried out a genotypic selleck bio analysis on our medical ICU. This analysis eliminated an exogenous epidemic spread but showed that P. aeruginosa colonization was associated with tap water contamination over several weeks. It suggested, together with an overall incidence of 11.3 colonized/infected cases per 100 patients, an endemic P. aeruginosa context [3]. However, this study had several limitations. Only genotyping from one colony of each culture was performed so that only one-third of the strains were analysed. Thus, it was not possible to ascertain which acquisition mechanism predominated. More importantly, the potential role of antibiotic selective pressure on acquisition was not studied. Based on the same study population, the aim of the current study was to explore the respective roles of environment and antibiotic selective pressure on P.
aeruginosa colonization during healthcare delivery in these endemic conditions.Materials and methodsStudy settingThe study was performed on a 16-bed medical ICU in a 1,624-bed university teaching hospital between April and November 2003 (29 weeks). Patients were treated in single rooms distributed on four wards of four rooms each. Other rooms such as a rest area, sterilization room (a room dedicated to sterilization of medical devices), toilet, equipment storage room, office and night duty bedroom were shared (Figure (Figure1).1). Each room had its own water tap. The nurse:patient ratio was 1:4. The antibiotic policy and hygiene protocols were not modified during the study period.
No digestive decontamination was used on the ICU. Twice monthly chlorine tap water disinfection was started in July (Week 11). Hygiene protocols consisted of contact barrier precautions for medical and nursing staff caring for patients colonized or infected with multi-resistant microorganisms (not including P. aeruginosa). These precautions were applied systematically on admission of previously hospitalized patients from other medical or surgical units for more than 48 h and for known carriers. P. aeruginosa carriers were identified on admission from rectal and oropharyngeal swabs. No screening was performed at discharge. Hand hygiene procedures were emphasized routinely.Figure 1Schematic representation of the 16-bed medical ICU.PatientsAll patients admitted during the study period were systematically included in a prospective cohort.
Secondary exclusion criteria included: length of ICU stay <72 h and carriage of P. aeruginosa on admission. These patients were, however, considered as potential P. aeruginosa environmental Entinostat sources as they were present in the ICU. Data were recorded prospectively each day until P. aeruginosa colonization/infection, death, discharge to another unit, or end of the study period.
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